Horace Roman

IFEMEndo

Diaphragmatic endometriosis is one of the most common localization of extra-pelvic endometriosis and may cause debilitating symptoms such as cyclic shoulder pain, right upper abdominal pain, and right-sided chest pain. Diaphragmatic endometriosis may also be asymptomatic. The exact mechanisms by which diaphragmatic endometriosis originates are unkn...

Endometriosis is a complex gynecologic disorder characterized primarily by symptoms of pelvic pain, infertility, and altered quality of life. National and international guidelines highlight the diagnostic difficulties and lack of conclusive diagnostic tools for endometriosis. Furthermore, guidelines are becoming questionable at an increasingly rapi...

Minimal/mild endometriosis (MME) is independently associated with reduced fecundity rates. In this review article, we discuss the role of laparoscopic surgery in enhancing the fertility outcomes of patients with MME. Laparoscopic management of MME enhances fecundity and increases the chances of spontaneous conception in appropriately selected cases...

To assess the diagnostic efficacy of an MRI protocol and patient preparation in detecting deep pelvic endometriosis (DPE). The cohort is from the ENDOVALIRM database, a multicentric national retrospective study involving women who underwent MRI followed by pelvic surgery for endometriosis (reference standard). Two senior radiologists independently...

Study question: Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure? Summary answer: This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien-Dindo Grade III complications overall, an...

Objective To compare robotic‐assisted laparoscopy (RAL) and laparoscopy (LPS) for intraoperative and postoperative outcomes, and functional results after a 6‐month follow‐up period among patients having undergone excision of deep endometriosis (DE) involving the sacral plexus (SP) and sciatic nerve (SN). Methods A retrospective analysis of 100 pat...

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparos...

Objective To evaluate the rate and risk factors for anastomosis leakage in patients undergoing colorectal resection with low anastomosis for rectal endometriosis and rectal adenocarcinoma. Methods A retrospective cohort study evaluating prospectively collected data was conducted. Patients undergoing colorectal resection for rectal endometriosis an...

Introduction Endometriosis is a chronic disease that affects up to 190 million women and those assigned female at birth and remains unresolved mainly in terms of etiology and optimal therapy. It is defined by the presence of endometrium-like tissue outside the uterine cavity and is commonly associated with chronic pelvic pain, infertility, and decr...

Endometriosis is a benign gynecologic affection that may lead to major surgeries, such as colorectal resections. Rectovaginal fistulas (RVF) are among the possible complications. When they occur, it is necessary to adapt the repair surgery as best as possible to limit their functional consequences. This video shows three different techniques for co...

Bowel endometriosis is the most common form of severe deep endometriosis. Surgery is an option in case of infertility and/or chronic pain or in the presence of a stenotic lesion. Clinical examination and preoperative imaging must provide an identity card of the lesion so that customized surgery can be proposed. The primary objective of this tailor-...

Aim: The aim was to compare postoperative complications in patients undergoing the excision of a rectal endometriotic nodule over 3 cm by a robotic-assisted versus a conventional laparoscopic approach. Methods: We conducted a retrospective cohort study evaluating prospectively collected data. The main interventions included rectal shaving, disc...

Ovarian endometriomas have a negative impact on a patient's reproductive potential and are likely to cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-Müllerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol...

Ovarian endometriomas have a negative impact on a patient’s reproductive potential and likely cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-mullerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol sclero...

BACKGROUND: The discovery of a saliva-based micro–ribonucleic acid (miRNA) signature for endometriosis in 2022 opened up new perspectives for early and noninvasive diagnosis of the disease. The 109-miRNA saliva signature is the product of miRNA biomarkers and artificial intelligence (AI) modeling. We designed a multicenter study to provide external...

Objective: To present the robotic standardized and reproducible surgical technique we routinely used in our center to manage isolated endometriosis of sciatic nerve. Design: Surgical video article. Setting: Tertiary referral center. Patient: A 36 years-old woman suffering from left-sided sciatica pain with diagnosis of isolated endometriotic...

Importance: Preoperative mapping of deep pelvic endometriosis (DPE) is crucial as surgery can be complex and the quality of preoperative information is key. Objective: To evaluate the Deep Pelvic Endometriosis Index (dPEI) magnetic resonance imaging (MRI) score in a multicenter cohort. Design, setting, and participants: In this cohort study, t...

Accurate diagnosis and assessment of endometriosis by transvaginal ultrasound scan (TVS) can be challenging. We performed an online survey of specialist gynecologists who perform TVS on a regular basis regarding their views as well as clinical experience on the use of TVS in the diagnosis of endometrioma and deep endometriosis (DE). We collected 64...

BACKGROUND The management of chronic pelvic pain in women with endometriosis is complex and includes long-term use of opioids. Patients not fully responsive to drugs, or ineligible for surgical treatments need efficient alternatives to improve their quality of life and avoid long-term sequelae. OBJECTIVE This randomized controlled trial, software...

Background The management of chronic pelvic pain in women with endometriosis is complex and includes the long-term use of opioids. Patients not fully responsive to drugs or ineligible for surgical treatments need efficient alternatives to improve their quality of life and avoid long-term sequelae. Objective This randomized controlled trial aimed to...

Study objective: To highlight the anatomic keys in order to perform safely an excision of deep endometriosis nodule of sciatic nerve DESIGN: We present a didactic video combining: an anatomic three-dimensional reconstruction of the pelvis using the Anatomage® table and a surgical dissection video of the removal of deep endometriosis nodule of the...

Study objective: To describe the robotic full-thickness rectal excision using a transanal circular stapler in rectovaginal endometriosis nodule infiltrating the rectum over 3 cm. Design: Surgical video article. The local IRB was consulted and ruled that approval was not required for this video article, because the video describes a technique and...

Objective: Deep endometriotic lesions may involve the deep parametrium which is highly vascular and includes numerous somatic and autonomous nerves (1,2). Surgeons who dissect in this area, must always be prepared to deal with major bleeding, and to master the different techniques of hemostasis. The goal of this video is to show the steps of lapar...

Endometriosis nodules of the low rectum and vagina are a challenging localisation of deep infiltrating endometriosis. Various surgical approaches can be utilized to safely excise them. Our patient presented with a symptomatic rectovaginal endometriosis nodule with bilateral parametrial involvement and left‐side extension to S3 sacral root. We perfo...

Endometriosis is a common gynaecological disease, causing symptoms such as pelvic pain and infertility. Accurate diagnosis and assessment are often challenging. Transvaginal ultrasound (TVS), along with magnetic resonance imaging (MRI), are the most common imaging modalities. In this narrative review, we present the evidence behind the role of TVS...

Training and education in diagnosis and therapy of endometriosis.

Study Objective To report a large series including women managed by disk excision using end-to-end anastomosis (EEA) circular transanal stapler to assess the feasibility of the technique, the features of nodules suitable for removal by disk excision and the rate of major early complications. Design Retrospective study on data prospectively recorde...

Objective To present different approaches used in the surgical management of diaphragmatic endometriosis using the Davinci Robotic system. Design A video article presenting patient positioning, port placement, and surgical techniques used in robotic excision of diaphragmatic endometriosis with concomitant pelvic disease. Setting Endometriosis cen...

Study Objective To compare postoperative complications and rectovaginal fistula rate in women undergoing excision of large rectovaginal endometriosis requiring concomitant excision of rectum and vagina during two time periods with differing policies for preventive stoma confection. Design Retrospective before-and-after comparative cohort study on...

Objective To compare first-line surgery with first-line assisted reproductive techniques (ART) in infertile women with deep infiltrating endometriosis (DIE) without colorectal involvement. Study design: A retrospective comparative cohort study with a propensity-score matching analysis, in four tertiary-care referral centers. The population was infe...

Study objective: To evaluate the impact of laparoscopic sclerotherapy on the management of endometrioma during surgery for deep infiltrative endometriosis (DIE). Design: Observational study SETTING: Tivoli-Ducos Clinic, Bordeaux. Patients: Sixty-nine patients underwent laparoscopic sclerotherapy for endometrioma during surgery for DIE. Interv...

Objective The present work aimed to investigate the feasibility, complications, recurrence rate, and infertility outcomes of the radical and conservative surgical methods for colorectal endometriosis in short- and long-term follow-ups. Methods In this prospective study, the patients with confirmed diagnosis of colorectal DIE were included from Mar...

Background and aim: Irritable bowel syndrome (IBS), eating disorders (ED) and endometriosis share common pathophysiological mechanisms, involving alterations of the gut-brain axis. The aim of the ENDONUT pilot study was to investigate an association between these three diseases by screening for IBS and ED in patients with endometriosis. Method:...

Objective To compare differences in the postoperative pregnancy rate in women seeking to conceive and presenting with endometriomas larger than 3 cm in diameter, which were managed by ablation using plasma energy, cystectomy, or simple drainage. Methods A retrospective three‐arm comparative study based on prospective collection of data evaluating...

Study Objective To describe our experience with the use of Natural Orifice Specimen Extraction (NOSE) technique for segmental bowel resection in patients with colorectal endometriosis. Design Retrospective, observational study. Setting Single tertiary referral centre Patients 50 consecutive patients undergoing NOSE colectomy for colorectal endom...

BACKGROUND Chronic pelvic pain is a frequent debilitating condition in women suffering from endometriosis. Pharmacological and surgical treatments are not always efficient in controlling pain and present important restriction. Digital Therapeutics (DTx) are emerging as major non-pharmacological alternatives, aiming to extend the analgesic therapeut...

Background Chronic pelvic pain is a common and disabling condition in women living with endometriosis. Pharmacological and surgical treatments are not always effective at controlling pain and present important restrictions. Digital therapeutics (DTx) are emerging as major nonpharmacological alternatives that aim to extend the analgesic therapeutic...

Surgical management of rectal endometriosis may employ two approaches: (i) conservative, with the preservation of overall rectal shape by either shaving or disc excision and (ii) radical, by segmental colorectal resection. There are numerous retrospective case series, a few comparative cohorts with prospective recording of data, as well as a random...

Transvaginal sonography is the first-line imaging technique to diagnose endometriosis, but magnetic resonance imaging is more accurate in staging the extent of lesions, especially for deep pelvic endometriosis. The revised American Society for Reproductive Medicine and Enzian classifications are commonly used to stage the extent of endometriosis. H...

Introduction Deep infiltrating endometriosis (DIE) affecting the rectum or sigmoid colon is associated with infertility, severe pain and decreased quality of life. As most women with DIE are young, many have a pregnancy intention. Treatment possibilities of endometriosis-associated infertility are surgery or assisted reproductive technologies (ART)...

Summary Objective : To present 10 standardized steps of the surgical management of diaphragmatic endometriosis using Da Vinci robotic assistance. Design : Surgical education video. The local IRB confirmed that the video met ethical criteria required for publication. Patient consent was obtained. Setting : Tertiary referral center Intervention : The...

Objective To present 10 consecutive, standardized, and reproducible surgical steps for laparoscopic sclerotherapy of an endometrioma. Design Step-by-step video demonstration of the technique. Local institutional review board approval was not required for this video because patients cannot be identified. Setting Endometriosis Center. Patient(s) W...

Study Objective To compare functional outcomes, recurrence rate and pregnancy likelihood in patients undergoing conservative or radical surgery in patients with deep rectal endometriosis 7 years post-operatively. Design Prospective study in a cohort of patients enrolled in a 2-arm randomized trial from March 2011 to August 2013. Setting A tertiar...

Introduction et but de l’étude Le syndrome de l’intestin irritable (SII), les troubles du comportement alimentaire (TCA) et l’endométriose partagent des mécanismes physiopathologiques communs, impliquant des altérations de l’axe intestin-cerveau. Le but de l’étude pilote ENDONUT était de rechercher une association entre ces trois pathologies en dép...

Background: Endometriosis is a common benign gynaecological disease that affects pelvic structures and causes adhesions. Endometriosis outside the pelvis exists but is rarer. Deep endometriosis may affect organs such as the urinary bladder, ureters, bowel and sacral roots. Adenomyosis (growth of endometrium in the myometrium, sometimes explained b...

Morbidity and mortality alone are not comprehensive measures of evaluating the benefits of surgical interventions in endometriosis patients, thus, subjective patient-reported instruments are required. The 36-tem Short Form Survey (SF-36) is a Health-Related Quality of Life (HRQoL) instrument that has not been validated yet for women with endometrio...

Study Objective: To assess what degree can digestive symptoms improve after endometriosis surgery for different localisations? Design: A comparative retrospective study employing data prospectively recorded in The North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) from June 2009 to November 2018. Setting: Two referral...

Resumen La endometriosis digestiva es la localización no ginecológica más frecuente. Por tanto, los equipos quirúrgicos que tratan esta patología se ven enfrentados a ella con frecuencia. Se han descrito y desarrollado técnicas menos «radicales» que la resección segmentaria y cada vez las utilizan más equipos en la actualidad. El shaving rectal par...

Introduction: Although live surgeries are routinely included in surgical congress programs, they are the subject of an ongoing debate in terms of patient safety and teaching value. The goal of our study was to assess the risk of postoperative complications related to live surgery broadcast from the surgeon's routine theater, in patients managed fo...

Aim: To assess whether placement of a biological mesh (Permacol®) between the vaginal and rectal sutures reduces the rate of rectovaginal fistula, in patients with deep rectovaginal endometriosis. Methods: We report a retrospective, comparative study enrolling patients with vaginal infiltration > 3cm diameter and rectal involvement in two center...

Colorectal deep infiltrative endometriosis (DIE) can have a major impact on patient’s health and quality of life. Surgical treatment of colorectal DIE varies depending on the location and characteristics of the lesions, which is why the preoperative non-invasive diagnosis needs to be correct and complete. Multiple imaging methods are currently avai...

Objective To present 10 standardized and reproducible surgical steps allowing for complete excision of deep endometriosis nodules involving the sciatic nerve. Design Surgical education video. The local IRB confirmed that the video met ethical criteria required for publication. Patient consent was obtained. Setting Tertiary referral center Interv...